Artikel
Frailty and temporal muscle mass as predictors of immunotherapy response and overall survival in patients with brain metastases of non-small cell lung cancer
Gebrechlichkeit sowie das Volumen des Muskulus temporalis sind Prädiktoren für das Ansprechen auf die Immuntherapie und das Gesamtüberleben bei Patienten mit Hirnmetastasen bei NSCLC
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Autoren
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Harald Krenzlin
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Florian Ringel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Naureen Keric
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Brain metastases occur in up to 40% of patients with advanced non-small-cell lung cancer (NSCLC) and are ause of death in half of the cases. Therapy with checkpoint inhibitors (CPI) has activity in brain metastases with PD-L1 expression of at least 1%. As lung cancer is diagnosed mainly in old age, frailty is common. We aim to evaluate the prognostic relevance of frailty and temporal muscle volume (TMV) on CPI after surgery for brain metastasis patients with NSCLC.
Methods: Data acquisition was conducted as a single-center retrospective analysis. From January 1st, 2016, to December 31st, 2020 patients presenting to our department with brain metastasis from NSCLC were included in our study. Before surgery, demographic data, tumor size, and the Groningen Frailty Index (GFI) were compiled. In addition, temporal muscle volumetry as a surrogate for sarcopenia was performed using T1 weighted MRI images using iPlan cranial (Brainlab AG, Munich). All patients received CPI at least during first-line treatment.
Results: 50 consecutive patients were included in our study. The mean patient age was 76.86+-4.11 years. 28 (56%) patients were female, 22 (44%) male. 12.2% had more than one lesion, while 10% were infratentorial. All patients underwent microsurgical resection of at least one lesion. The mean PD-L1 expression of the cerebral lesion was 39.47+-6.26%. Fifteen patients (30%) were defined as frail (GFI > 3), 35 (70%) as not frail. Mean temporal muscle volume was 16.9 +-10.02 cm3. By setting the median value of the TMV as a reference, 20 (40%) patients showed signs of sarcopenia. Mean PFS was 16.5+-13.95, mean OS 21.78+-16.21. Survival after the detection of brain metastasis was 14.34+-13.41. In our cohort, frailty and TMV were independent from chronological age (GFI: r2= 0.204; TMV: r2= 0.101). Frailer patients had a statistically significant smaller TMV (11.98+-5.7 cm3, p= 0.002) compared to those defined as not frail (23.99+-10.7 cm3, p= 0.002). The expression of PD-L1 in brain metastasis was independent from frailty (p= 0.43) and TMV (p= 0.51). However, frailty and reduced TMV were associated with a decreased response to CPI and shortened OS after the occurrence of brain metastasis (p= 0.0032).
Conclusion: Frailty and sarcopenia are associated with a shorter PFS and OS in patients with NSCLC and brain metastasis. The response to CPI was impaired independent from the PD-L1 expression profile. This might influence surgical decision-making in complex oncological situations.
